Crisis in obstetrics looming, says NHS

THE NHS is facing a crisis in maternity care which is threatening the safety of women in childbirth, according to a senior civil servant in the Department of Health.

In a leaked letter seen by The Independent, Hugh Taylor, director of personnel at the NHS executive, says hundreds of doctors trained as consultant obstetricians face redundancy over the next three years because there are too few consultant posts. The shortage is putting women at risk because there is little back-up for junior doctors and midwives, Mr Taylor says.

The letter, sent to the NHS chief executive Alan Langlands and other senior staff on 28 April, says the ratio of consultants to juniors in obstetrics is lower than in most other specialities and that "litigation costs dwarf those in all other specialities". It cites the Confidential Enquiries - biannual reports analysing the causes of infant and maternal deaths - which pointed to examples of "substandard care arising from inappropriate delegation to inexperienced junior staff".

It is the first admission by the Department of Health of the depth of the crisis facing obstetrics and gynaecology. It bears out claims by the British Medical Association in March that by May 2001 up to 400 specialists, trained at a cost of pounds 40m, would have to leave medicine, find work abroad or start a new five-year training course in a different specialty because of the shortage of consultant posts in obstetrics.

The letter says "the relevant facts can be starkly presented". By the end of 1998 there were 112 doctors who had completed their training in obstetrics but remained "unplaced". Over the next three years, another 422 are expected to complete their training but the growth in the number of consultants would have to more than double to 10 per cent a year from its current 4.5 per cent to accommodate them all.

The training had been extended by 18 months to lessen the impact of the problem but for 26 doctors that extension had already ended. They were serving periods of three months notice "after which they will, effectively, be unemployed unless they can find posts", Mr Taylor says.

The letter notes that NHS trusts are appointing obstetricians to non- consultant career grade posts, which attract lower salaries. Over the past year, 37 such appointments have been made compared with 50 consultant appointments.

Evan Harris, the Liberal Democrat health spokesman, who obtained the letter, said: "It is astonishing that the Government can allow ready- made consultants to be lost to the NHS when it is clear that substandard care is being given due to inadequate consultant numbers."

t NHS trusts are facing bills of almost pounds 3bn for medical negligence claims, according to a government watchdog. The huge rise in compensation claims is a "major challenge", said Sir John Bourn, head of the National Audit Office, in its report on the financial performance of the NHS.

The 100 health authorities in England are facing potential liabilities of pounds 1.8bn for 1998, up from pounds 1.3bn in 1997. Clinical accidents which have occurred since the accounts were prepared, and for which claims are expected, could add a further pounds 1bn, making a total of pounds 2.8bn.